Realizing Peoples Right to Health is a main areas of advocacy. RECPHEC has been involved in this issue through different programme intervention. It can be catagorized broadly into the followings
Policy Advocacy to the state, lobby and advocacy to Legislative members including leading political parties, mass awareness campaign at district and community level, media mobilization, networking with like minded NGOs for collective action and active participation in regional and global campaign are some of the on-going initiatives. Its role in MDG, Universal Health Coverage, Sustainable Development Goal including district level monitoring of Free Health & maternal services are some of the major intervention of RECPHEC.
1. Consultation Meeting on Role of NGOs in Realizing People’s Right to Health: The world has witnessed peoples continue struggle to realize “Right to Health for more than 6-decades. The establishment of World Health Organization in 1944 was one of the major achievements.After more than 2-decades of its establishment all the member states came with Alma Ata declaration in 1978 demonstrating the firm commitment to realize “People’s Right to Health”. The people have passed through long journey from Alma Ata to Health for All by 2000 & MDG Goal of 2015 & now moving towards the Sustainable Development Goal towards universal health coverage. Responding to these global initiatives the National Health Policy of 1996 enshrines a commitment to provide free health services complimented by the Nepal Health Sector Implementation Plan. In addition to this, Nepal being the member of International Health Partnership 2007, made utmost effort to successfully launch “Country Compact” with the firm commitment from external development partners. Nepal has made significant achievement in maternal & child health meeting the MDG target. Learning from these initiatives Nepal formulated Nepal Health Policy 2015 with a goal: provide health services through equitable & accountable health system while increasing access of every citizen to equity health services for ensure health as a fundamental human right to every citizen.
As a signatory to the Sustainable Development Goal 2030, Nepal is aggressively formulating Plan of Action in line with SDG. Hence, in line with country’s changed political context, more than one hundred NGOs & civil societies joined hand to collectively celebrate “Human Rights Magna Meet’ on December 2015& participation in mass rally, book exhibition & other thematic workshops. As a partner to this meet, RECPHEC organized “National Consultative Meeting on Role of NGO in Realizing People’s Right to Health” on 18th December 2015 with the objectives to critically analyze the role of the state in realizing people’s right to health; gender mainstreaming in health of the people with special focus to women’s health & to identify the role of non-state sector specially NGOs in advocacy & facilitating the state system. Altogether 60-representatives from different organizations including government, non-government & other organizations participated in this program.
Mr. Gauri Pradhan, International Coordinator, LDC WATCH presented a key note presentation on People’s Right to Health: A global & National Perspective. Followed by remarks from Ms. Nirmala Sharma, AIN, Ms. Shanta Laxmi Shrestha, Coordinator of Beyond Beijing Committee & Mr. Gopal Lamsal, Chairperson, NGO Federation. Different paper on thematic issues were presented: Realizing People’s Right to Health with Special Focus on Women’s Health by Dr. Tirtha Rana, Nepal Public Health Foundation; Role of State in Realizing People’s Right to Health by Dr. Ramesh Kharel, Primary Health Care Revitalization Division; Consumer Protection Act & People’s Right to Health by Mr. Baburam Humagain, General Secretary, Forum for Protection of Consumer Rights Nepal; Status of Rural Water Supply & its contribution to Health & Sanitation in Nepal by Mr. Harish Neupane, Chief, Planning & Operation Division, Rural Water Supply and Sanitation Fund Development Board gave presentations for thematic discussion.
2. Health Rights & Tobacco Control District Network
Health Rights & Tobacco Control District Network (HRTC) was formed to pressurize concerned authorities to address various public health issues across the country. Throughout the years the network has played a key role in creating awareness among community people regarding health rights & tobacco control issues, maternal health, traditional health, non communicable diseases & other key public health issues. HRTC, with support from RECPHEC, has been organizing interaction meetings, orientation, workshops, rallies & campaigns in their respective districts to address right to health issues. They have been coordinating with district health office (DHO), village development committee (VDC), health posts (HPs) and sub health posts (HPs) to carry out different activities.
Formed on voluntary basis, at present there are 57-districtnetworks, which covers: Sunsari, Morang, Jhapa, Ilam, Dhankuta, Sankhuwasabha, Panchthar, Tehrathum, Siraha, Saptari, Udaypur, Bara, Parsa, Mahottari, Sarlahi, Dhanusha, Rautahat, Makwanpur, Kavrepalanchowk, Bhaktapur, Rupandehi, Kapilvastu, Argakhanchi, Nawalparasi, Gulmi, Palpa, Lamjung, Tanahu, Chitwan, Dhadhing, Gorkha, Parbat, Syangja, Myagdi, Baglung, Kaski, Banke, Bardiya, Kalikot, Jajarkot, Salyan, Surkhet, Dailekh, Jumla, Mugu, Dang, Achham, Doti, Kailali, Darchula, Bajura, Bajhang, Dadeldhura, Baitadi, Kanchanpur, Khotang, Sindhuli districts.
2.1 Fact Finding Study on Tobacco Control Implementation Law on 75%Pictorial Warning in 10-HRTC Districts: During the month of February & March 2015, 10-districts (Bhaktapur, Kavre, Dadeldhura, Kailali, Makwanpur, Kanchanpur, Rupandehi, Sarlahi, Saptari, Dhankuta) conducted a brief study to gather information on the implementation of tobacco control law on 75% pictorial warning in their respective districts. The study was based on separate interviews with assistant chief district officer, 10-shop-owners & 20-consumers in each district. Questionnaire was prepared for separate interviews.
From the study, it was concluded that the district health office (DHO) in all 10-districts have implemented tobacco control law on 75% pictorial health warning. Based on monitoring from DHO, it was noted that although the law is present, due to lack of strict rules shopkeepers have been selling tobacco products without pictorial images. According to the status, these products were either imported from neighboring districts of India or are locally manufactured products. Similarly while most of the shopkeepers sold cigarettes & other tobacco products, they did not display any kind of brochure/hoarding board with health warning message within or outside their shops. Furthermore, although most of the consumers acknowledged the risk of tobacco consumption they continued its purchase as well as smoking. The study showed that people are aware of risk associated with tobacco consumption; however, due to habitual behavior people have not been able to decrease or stop smoking. It was also learned that the representatives of DHO urged the need of increased responsibility in monitoring process. Moreover, it was learned that awareness message should be spread through various media such as radio, television, newspapers to reach the target audience as well as to introduce stricter rules by government.
2.2 National Conference of Health Rights & Tobacco Control Network: RECPHEC coordinated National conference of Health Rights and Tobacco Control Network (HRTCN) on 30th and 31st March 2015. The conference mainly focused on 9-major health issues. These include: 1) Epidemic & government response by Dr. Baburam Marasini; 2) Alcohol policy & its update by Ms. Sumnima Tuladhar; 3) Life style & NCD by Dr. Prakash Raj Regmi; 4) Tobacco control law & its journey to 90% package warning by Mr. Babu Kaji Baniya; 5) Kidney failure & transplant by Dr. Pukar Shrestha; 6) Advocacy at district level by Mr. Shanta Lall Mulmi; 7) Status of primary health care in Nepal by Dr. Ramesh Kharel; 8) Reproductive health: Uterine prolapse & traditional health system by Dr. Sarita Shrestha; 9) Diabetes & health risk in Nepal by Dr. Jyoti Bhattarai. Representatives of 57-HRTC districts took part during the conference where health experts gave insightful presentation on above mentioned public health issues.
During the conference valuable exchange of information took place between health experts and participants on key public health issues. The conference also gave opportunity to all the participants to understand the public health issues closely & update about the current public health measures taken up by the government. Similarly, participants from HRTC district network realized the significant role of HRTC district network in raising key public health issues in their districts. They also understood their role in pushing policy makers to address the national health issues more effectively, not only in central region but also at district level.
2.3 Orientation Training to HRTC District Network on Right to Health: Although in Nepal the government has made commitment to fulfill people’s basic health rights the implementation of the activities is yet not to the mark. Women face discrimination in the family, society, & state. Many districts are remote, making access to health services & information are very limited. There is little knowledge on preventive measures of various health & nutritional problems. Also women’s health issues remain inappropriately addressed in the national health policy & programs. Therefore, it is necessary to provide primary health care facilities & to make communities aware of their basic rights to health. It is vital that the district coordinators should be trained on right to health issues to highlight them in their respective districts.
Based on this background RECPHEC organized a 2-Days “Orientation training to HRTC district on Right to Health” from 28th-29th of June 2015 in Kathmandu. Participants from 11-HRTC: Dhankuta, Jhapa, Kavre, Dhanusha, Sarlahi, Tanahu, Rupenedehi, Kapilvastu, Kanchanpur, Bake & Surket and 3-outreach districts; Udaypaur, Saptari & Gorkha took part. The 2-days training highlighted different health issues related to right to health which included a) Role of HRTC network in identifying right to health issues/violation by Mr. Shanta Lall Mulmi; b) National policy on right to health & its implementation by Dr. Baburam Marasini; c) Civil society’s role on right to health by Dr. Sharad Onta and d) Government’s effort in realizing people’s right to health in relation to free health & free maternal services by Dr. Ramesh Kumar Kharel.
All the participants took keen interest on different issues related to right to health. They discussed & pointed out that health should be the basic & essential asset of all the citizens of Nepal regardless of age, gender, socio economic or ethnic background. While sharing their case studies on different health right issues in the districts & communities, they stressed the need of all stakeholders including state, NGOs, civil society networks, and others to show genuine effort in realizing the goal of right to health to all.
2.4 Orientation on Right to Health to Concerned VDC/HPs: In the month of October-November 2015, 10-HRTC districts(Tanahu, Palpa, Myagdi, Bhaktapur, Surkhet, Dhankuta, Saptari, Darchula, Banke, Kanchanpur) organized “Orientation on right to health to concerned VDC & Health Posts (HP)” in their respective districts. At the initial stage each district selected 2-VDCs & 2-Health Posts respectively. The HRTC district coordinator, in coordination with district health office, organized orientation meeting in selected VDC/HPs. Members of district health office, VDC, health post representatives, female health volunteers as well as community members participated in the program. During the meeting participants were oriented on right to health issues including national initiation towards right to health. The meeting also addressed national health policy, free health services of Nepal. During the meeting, participants shared that they have learned & updated information on right to health issues including equal rights of people towards health facilities. However, they also put forward certain issues such as need of increasing awareness program in communities regarding different female health issues such as uterine prolapse. It was also revealed that women do not visit health centers for delivery as well as for vaccination due to lack of awareness among women regarding health facilities. Similarly, health post in-charge assured to continue their efforts in improving health delivery services at their health posts & also to deliver free health services in coordination with district health office. Participants also discussed that most of the health centers receive medicines irrespective of the need of the community members. For this, they urged that each health center should receive essential medicines based on the cases they receive to save the resources.
2.5 Interaction Meeting on Budget Allocation for Health at VDC Level: While talking about health rights of people, it becomes necessary to understand the status of budget allocation for health in VDCs & also understand how the budget is being used in various health services. In this context, 10-HRTC districts organized an interaction meeting to discuss about the situation where VDC secretary, health post in-charge, community people and civil society representatives participated. Discussion was based on three questions: a) Has VDC played significant role in people’s right to health? b) How much budget is allocated for health by VDC? c) Has this contributed in preventive and treatment facilities for people in VDC?
From the meeting, it was learned that VDCs have been playing important role in addressing health rights of people. While most of the VDCs have allocated specific budget for children, women, target groups as well as marginalized communities, there have not been any specific budget separated for health services. In other words, budget has been used in health care according to the need of the communities. It was shared that most of the VDCs have utilized budget allocation for women (which is 10% of the total budget allocated for VDC) for health care facilities such as providing incentives for FCHVs, providing nutrition & health services to children and women, organizing essential equipments at birthing center, buying refrigerator for storing vaccines, arranging food & transport facilities for FCHVs for attending meeting, salary support for vaccinator, purchase of extra medicines, establishing waiting room & health post maintenance.
During the meeting, it was also shared that people in the communities are not aware of their rights. While people see only infrastructure as development indicator, they lack knowledge on how allocated budget should be or are being utilized in their communities as they need to. Also, although there is health policy, there is no clear guideline on how budget should be spent on health facilities. Discussion also took place stating that though budget is separated, but due to lack of proper monitoring by concerned authorities, they have not been utilized properly. Therefore it was suggested that 1) All the stakeholders involved in health sector should address these issues collectively, 2) There should be proper coordination between local authorities & Ministry of Health to minimize the gap at local level.